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Poor latch with high palatial arch post tongue-tie division

I am currently struggling with bf my 13 week old and want to see if anyone has any advice/similar experiences. He has never latched on well and was cup and tube fed EBM and formula in hospital then at home until about week 3 as he was very lethargic due to jaundice. From week 3-6 we were able to EBF and his weight gain was all right (approx. 150g a week), though nursing was never comfortable and my nipples became sore and cracked. At 6 weeks he was evaluated for tongue-tie by a lactation consultant and determined to have a posterior tongue-tie which she divided. The pain went away but his weight plateaued and for a few weeks he hardly gained anything at all so we started supplementing with EMB. We went back to the lactation consultant at 8 weeks and the division had scarred over so she divided it again.

In the meantime he still wasn’t gaining weight so we have had to supplement him with more and more with EBM. Now at approx. 500 ml of EMB a day) he is finally gaining enough weight. Yesterday at 13 weeks, we went back to the lactation consultant who said that he also has a high palatial arch which does not allow him to create good suction and feed efficiently even though his tongue is now able to work properly. She said it might get better or might not- not so much evidence as many people give up by this point.

I am very tired, not sure of how to combine bf and bottlefeeding into a routine that feels manageable, gets him and me some sleep while also pumping milk 5 times/day (I usually bf him for 20-40min, then top up with bottle but then sometimes he still seems hungry and wants to bf again, which when you add on expressing means that I can be up for 2 hours at night). He feeds about every 4 hours during the day (though the feed takes over an hour) with sometimes another 5-10 min feed before nap time. I wonder if he should be feeding more often but as it takes so long I am not sure how to do this and when I try to feed him before nap time he will only feed for a few minutes and fall asleep which I am not sure if I should encourage. I would love to hear any advice or ideas on how to manage breast and bottle-feeding together. as well as stories of whether babies with these issues can eventually EBF. It has always been my plan to EBF for at least a year for the bonding and health benefits but not sure how long I can do this.

Re: Poor latch with high palatial arch post tongue-tie divis

Hi there,

We had strong posterior TT, poor latch post division, poor weight gain, an m shaped palate, and needed to supplement for a chunk of time, (http://forums.llli.org/showthread.php?119971-17-week-old-on-the-verge-of-failure-to-thrive)

here's what helped us...
A really good IBCLC who showed us how to do Tongue walk and suck training-we only did these for about 48 hours which was enough for my daughter to start latching in combination with an appointment with a sacro cranial osteopath. (These were done simultaneously so I can't say for sure which helped or both etc).

We ditched bottles as for us they made a poor latch worse and used a SNS to supplement. Other people do use bottles but make sure they are given in a paced manner.

We used the 'flipple', breast sandwiches and breast compressions to widen her latch.

With all this implemented her latch improved over 48 hours and we were feeding normally a couple of weeks later... We decreased the supplements over a 2 month period tho ewe could probably have done this faster I was worried about her weight still. That was finally over about 4 months ago and we are a happy bf dyad these days

Re: Poor latch with high palatial arch post tongue-tie divis

I went through quite a lot with my Son now 7 months old.
His tongue and lip ties were cut at 8 weeks but he also needed some oral motor therapy but I didn't get to start to see a speech therapist for that till he was 3 months old. Did the therapy for about 6 weeks and started taking domperidone for my supply at about 5 months since the pumping just wasn't effective enough for me and herbs didn't do much either.

We were supplementing very little through the 5th month and before 6 months we quit supplementing.

For us, I used the Medela SNS instead of bottles for the most part since the bottles seemed to cause more problems and by using the SNS I was able to cut out the separate supplement step of the triple feeding treadmill.

For me Feeding as often as baby will latch on is what is necessary. He almost never cues to feed because I am generally offering before he gets a chance. Even now at 7 months he is often eating 15 or more times a day. Granted he is now far more efficient at it. During his first 12-14 weeks he was usually taking 20-60 minutes to nurse which made it very difficult to pump after most nursing sessions. Life was like, nurse, pump, pee, nurse, pump pee.

Have you done any weigh feed weigh with the LC to see how much milk baby is able to transfer at a single nursing session? How is your supply? Do you respond well enough to the pump to actually keep your supply up while baby is having the milk transfer problems?

I highly recommend getting a referral to a speech therapist or some one who can do more suck training and oral motor exercises with you and your LO.

Did your LC give you exercises for after the tongue/lip procedure to help make sure they don't re-attach or scar up tight? Sometimes it happens anyway even with exercises but if they didn't even tell you to do exercises or stretching I would be seeking a new LC.

Re: Poor latch with high palatial arch post tongue-tie divis

There's quite an interesting debate on whether exercises post TT division are necessary and I wouldn't dismiss an LC just because they didn't recommend them. It should be discussed tho; esp with a reattachment.

Re: Poor latch with high palatial arch post tongue-tie divis

Well, with the re-attachment yes I do thing they are needed at least to make sure it isn't re-attaching.
But if the latch isn't immediately improved at least to a degree, I would definitely personally recommend some exercises especially if baby was more than a few weeks old when the division was done.

Re: Poor latch with high palatial arch post tongue-tie divis

Thank you everyone for your replies. We did do stretching exercises under the tongue after the second division to make sure it didn't scar over again an those seems to have worked. I was wondering if there were other exercises we could do to help strengthen his tongue but the LC didn't recommend anything when we saw her this week as she said the problem is now his palate not the tongue.

We go for our 4th cranial sacral therapy appt tomorrow- not sure if it has helped with his feedings but made him generally more settled.

We have tried SNS but I have struggled with it as it can take 90 minutes for a feed even with the larger tube (due to poor suction), we cup fed for a long time and just introduced the Medela Calma bottle last week which is made especially for breastfed babies and is so much easier.

He seems to be doing better even since yesterday and I am feeling much better so we'll see how we get on.

Re: Poor latch with high palatial arch post tongue-tie divis

There are exercises for the lips, cheek, jaw, and tongue that can all help with suction, tongue mobility/strength, being able to open wider and maintain suction.
The Tongue Walk is the one most LC's know but there are plenty of others.